Exercise helps women with arm and shoulder problems after breast cancer surgery.
Early postoperative exercise appears to help women recover better than receiving standard care only, study shows.
Women who exercise shortly after having non-reconstructive breast cancer surgery appear to regain better shoulder and arm mobility and experience less pain than those who receive standard care, suggests a recent study.
A team of researchers led by the University of Warwick believe the exercise program starting just a week after surgery is clinically and cost effective because it seems to reduce upper limb disability one year after breast cancer surgery in women at higher risk of complications.
Shoulder and arm problems are common after breast cancer treatment, with up to one-third of women experiencing restricted shoulder movement, chronic pain, or swelling (lymphoedema) in the armpit area, limiting the quality of life and delaying recovery.
Guidelines in the UK recommend gradual reintroducing exercise after non-reconstructive breast surgery. Still, there is a lack of good evidence about the ideal timing, intensity, safety, or impact of postoperative muscle strengthening.
To address this uncertainty, the researchers conducted a trial to evaluate whether a structured exercise program improved functional and health-related quality of life compared with usual care for women at high risk of upper limb disability after breast cancer surgery.
Their findings are based on 392 women (average age 58 years) undergoing breast cancer surgery at 17 (NHS) cancer centers who were at risk of postoperative upper limb problems. Women were randomized into two equal groups. Half received usual care (information leaflets) with structured exercise, and the other half received regular care.
The exercise program, known as the Prevention of Shoulder Problems (PROSPER), was led by physiotherapists and included stretching, strengthening, physical activity, and behavioral change techniques. It was introduced 7-10 days after surgery, with two further appointments one and three months later.
One year after surgery, the women were asked to complete a detailed questionnaire, and the researchers measured outcomes such as activity levels, pain, swelling, and quality of life.
The researchers also used hospital records to look at how often the women used health and personal social services. Results collected between January 2016 and July 2017 showed that upper limb function improved after exercise compared with usual care.
At 12 months, women in the exercise group reported lower pain intensity, fewer arm disability symptoms, and better health-related quality of life than those in the usual care group. No serious adverse events were reported.
However, there were no differences in the rate of neuropathic (nerve) pain, wound-related complications, surgical site infection, swelling, or other complications between the two different groups of women.
The study had some limitations in that participants and physiotherapists knew which treatment they were receiving (unavoidably), and there was some loss of participants when following them up.
Nevertheless, the study’s strengths included a substantially larger sample size than previous trials, a long follow-up period, and exercise delivered by physiotherapists from 17 different cancer units in various locations across England.
The authors conclude: “We found robust evidence that early, structured, progressive exercise is safe and clinically effective for women at higher risk of developing shoulder and upper limb problems after non- reconstructive breast surgery.
The PROSPER exercise program improved upper limb function one year after breast cancer surgery and was cost effective compared with usual care. Our manualized exercise intervention is suitable for broader implementation in clinical practice.”